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General NPI Number Information
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NPI Number | 1346058641
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Entity Type | Organization
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Legal Business Name | DR MARY GRACE RIZZO-FRYZEL DENTAL GROUP PLLC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 200 BETTY ST
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City | EYNON
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State | PA
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Zip | 18403-1258
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Country | US
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Telephone | 570-876-4719
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Fax |
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Provider Business Mailing Address
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Address Line | 300 LACKAWANNA AVE UNIT 107
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City | SCRANTON
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State | PA
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Zip | 18503-2001
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Country | US
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Telephone | 570-878-9959
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARY GRACE RIZZO-FRYZEL
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Credential | DMD
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Telephone | 570-878-9959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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